HIQA publishes advice on the transfer of paediatric transplant patients to the UK

HIQA has published a health technology assessment (HTA) that contains advice for the Minister for Health and the Health Service Executive on the alternative options for the treatment and transport of Priority 1 transfer patients. Priority 1 transfer involves the transport by air from Ireland to another country within eight hours of a patient requiring emergent medical or surgical treatment, without which the patient’s life or health is significantly endangered. To date, the majority of patients fulfilling these criteria have been children who require transfer to the UK to undergo heart or liver transplant surgery.

Since 2012, all Priority 1 transfers, with one exception, have been completed by the Air Corps or Irish Coast Guard (IRCG). Due to staff capacity constraints with the Air Corps and regulatory requirements on the Irish Coast Guard, these services have not been available to provide Priority 1 transfers between the hours of 7pm and 7.30am since 6 November 2017.

HIQA’s Director of Health Technology Assessment and Deputy Chief Executive Dr Máirín Ryan said “This HTA focussed on options for the treatment and transfer of paediatric heart and liver transplant patients. Based on our assessment, we have provided advice on immediate, short-term and long-term options for Priority 1 transfer patients.”

In the immediate-term, the optimal option is to engage a private provider to deliver a dedicated night-time service.

In the short-term (that is, to be implemented within the next six months), the optimal solution may be to negotiate changes to the existing IRCG contract to allow for 12 hour rosters at one or more bases, thereby enabling the IRCG to undertake night-time Priority 1 transfers. The cost of this option should be compared to the cost associated with the on-going use of a commercial provider or of having a dedicated IRCG crew on standby at the Dublin base.

Additional short-term recommendations are that the Department of Health both explores the use of an air ambulance service supported by philanthropy and examines whether the IRCG can fly patients to the UK under a 24 hour shift following changes to the regulatory framework.

The preferred long-term alternatives are those provided by the Irish Coast Guard or the Air Corps. The next contract to provide coastguard services in 2022 could provide for an additional aircraft and aircrew to provide air ambulance services. The Air Corps options include the provision of an air ambulance service on an “as available” basis or through a model similar to that used by the Garda Air Support Unit, where aircraft would be provided by the HSE and dedicated aircrew would be provided by the Air Corps. These options leverage existing state resources and are contingent on restoration of sufficient air crew capacity.

Dr Ryan continued “While we have presented immediate, short-term and long-term options for Priority 1 transfer patients, ideally, Priority 1 transfers should be considered as part of the wider patient transport services. The long-term development of an integrated aeromedical service for Ireland could provide a more sustainable approach and allow for more efficient use of resources than can be achieved by a service designed only for Priority 1 transfers.

“We realise the deep concern that the families of children awaiting heart and liver transplants must feel about how their loved ones can travel to the UK for a transplant, and we believe that the advice we have provided to the Minister and the HSE offers the best possible solutions in both the immediate future and in the longer term.”

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Notes to the editor

Health technology assessment (HTA) is a multidisciplinary research process that collects and summarises information about a health technology.

The information can cover a range of fields, including clinical effectiveness and safety, cost-effectiveness and budget impact, organisational and social aspects, and ethical and legal issues. The information is collected and presented in a systematic, unbiased and transparent manner.

The work on this HTA was supported by an Expert Advisory Group with representation from stakeholders with expertise and experience in the area.

Priority 1 transfers have been primarily provided by the Irish Air Corps and the Irish Coast Guard. Neither of these provides dedicated air ambulance services, but have provided the service on an “as available” basis.

In September 2017, HIQA agreed to undertake a rapid HTA following receipt of a request from the Office of the Chief Medical Officer at the Department of Health. The purpose of the HTA is to provide advice to the Minister for Health and the Health Service Executive (HSE) on the consequences of alternative options for the treatment and transport of Priority 1 transfer patients to the UK.

Patients must present at the transplant centre in the UK within four hours of notification of a donor heart becoming available and within six hours of notification of a liver becoming available.

To date, there has been between one and nine (average five) paediatric transplant Priority 1 transfers each year since 2012. Three quarters of Priority 1 transfers occur between 7pm and 7 am.

Selection of options for transport and treatment of Priority 1 patients should be guided by consideration of affordability, the impact on other state services, and crucially the requirement to maximise the delivery of safe, effective patient-centred care.